Rare form of basal ballooning without reduction of left ventricular function in takotsubo cardiomyopathy

Abstract

Fig. 1. Basal ballooning of a well-contracting left ventricle with an EF of 60%. A 54-year old female patientwas admitted to the hospital because of chest pain and dyspnoea together with arterial hypertension, diabetes mellitus type II and a weight of 110 kg. Severe episodes of stressrelated events were in the past history of the patient. ECGwasnormal under two controls. Troponinwas slightly increased but CK and CK-MB was normal. Echocardiography showed a well contracting left ventricle with inferior hypokinesia. Coronary angiography revealed normal coronary arteries with a dominant right coronary artery. Left ventricular angiography showed normal sized, hypertrophied left ventricular function with basal ballooning resembling takotsuko cardiomyopathy (Fig. 1). In conclusion, this is a very rare case of basal ballooning in stressrelated takotsubo cardiomyopathy with a frequency with about 1% [1]. Apical ballooning in takotsubo cardiomyopathy accounts for 85% and mid-ventricular ballooning for about 14%. Sometimes there is a mixture with apical and mid-ventricular ballooning in the sense of inferoapical contraction impairment [2]. The slight increase of troponin without CK and CK-MB rise is a diagnostic marker of takotsubo cardiomyopathy.